Iran Red Cres Med J. 2014 January; 16(1): e12313.

DOI: 10.5812/ircmj.12313
Research Article

Published online 2014 January 5.

Hepatoprotective Herbs, Avicenna Viewpoint

1

Hamid Shamsi-Baghbanan ; Afsaneh Sharifian ; Somayeh Esmaeili ; Bagher Minaei

4,*

1School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
2Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
3Traditional Medicine and Materia Medica Research Center, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
4Department of Traditional Medicine, Tehran University of Medical Sciences, Tehran, IR Iran

*Corresponding Author: Bagher Minaei, Department of Traditional Medicine, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2155693520, Fax: +98-2155693522, E-mail:
minaezb@tums.ac.ir

Received: May 19, 2013; Revised: July 2, 2013; Accepted: July 25, 2013

Background: Liver injury or dysfunction is considered as a serious health problem. The available synthetic drugs to treat liver disorders
are expensive and cause further damage. Hence, hepatoprotective effects of some herbal drugs have been investigated, and one of the
methods to choose herbs in order to study their biological effects is to search in ancient medical texts. Avicenna who is known as the prince
of physicians had collected and classified Greek, Persian and Islamic medicine in the best possible way in the book of Canon in Arabic.
Objectives: Avicennas book of The Canon of Medicine was reviewed to find the hepatoprotective herbs.
Patients and Methods: Three different versions of the Canon were prepared and utilized. To find scientific names of plants we took
advantage of three botany references. All of the herbs were investigated on the basis of scientific data from hepatoprotective effects point
of view. The searched term was hepatoprotective without narrowing and limiting. The searched databases included Cochrane library,
Web of science, SID, Irandoc and IranMedex.
Results: 18 plants were found. 85% of the presented species, genus or families of plants were reported to have hepatoprotective properties
and in the remaining 15% there were no reports of hepatoprotective effect. Flowers and fruits were the most used part of the plants. Most
of the plants had simultaneous protective effects on multiple organs but the protective effect on the liver was mostly accompanied by
protective effect on the stomach (83%). The average temperament of these herbs is "hot" in the 2nd phase of the 2nd grade, and "dry" in the
3rd phase of the 2nd grade. Hepatoprotective herbs mostly prescribed as a part of hepatoprotective compound drugs formula or other
formula for liver diseases are Crocus sativus, Pistacia lentiscus, and Cinnamomum spp.
Conclusions: Maybe there is common mechanism for protecting both liver and stomach. Aquilaria agallocha, Aquilaria malaccensis, and
Ruscus aculeatus whose hepatoprotective effects have not yet been reported are considered as good candidates for future investigations.
Given that Crocus sativus, and Cinnamomum spp are used as flavors in most countries, they will be introduced for more investigation in
order to produce hepatoprotective drugs.
Keywords: Plants, Hepatoprotective; Avicenna; Medicine, Traditional; Liver; Complementary Therapies

1. Background
Liver as the largest internal organ in the body, plays a
crucial role in many essential physiologic processes and is
vulnerable to a wide variety of toxic, microbial, metabolic, circulatory, and neoplastic insults. Surveillance studies in the United States document an annual incidence of
newly diagnosed chronic liver disease of 72 per 100,000
populations (1) and Liver diseases are considered as one
of the most serious health problems. On the other hand,
treatment options for common liver diseases are limited,
and therapy with modern medicine may lack efficacy. The
effectiveness of treatments such as those using corticosteroids and interferon is consistent, carries the risk of
adverse effect, and is often too costly (2). Hence, we are
in the need of new drugs with minor side effects. Clini-

cal studies demonstrated efficacy and safety of a number

of herbal products in the treatment of liver diseases (3).
Amongst the most important and proven cases of using
these herbs is utilizing them as hepatoprotective agents
(4). Studies revealed the value and worthiness of investigating Greek, Latin and other medical scripts in order to
get familiar with herbs, and choose them for pharmacological studies (5).
Avicenna, one of the most famous physicians of the
old era who is known as "the prince of physicians" in the
west is the author of The Canon of Medicine. The Canon
of Medicine presents a clear and organized summary of
all the medical knowledge of the time including Greek,
Persian and Islamic medicine. The Canon is considered as

Implication for health policy/practice/research/medical education:

The most frequently used plants as hepatoprotective for liver diseases by Avicenna were Crocus sativus, Pistacia lentiscus, and Cinnamomum spp. They are
proposed for more investigation and construction of hepatoprotective drugs. Plants such as Aquilaria agallocha, Aquilaria malaccensis, and Ruscus aculeatus whose hepatoprotective effects have not yet been reported are considered as good candidates for future investigations.

Copyright 2013, Iranian Red Crescent Medical Journal; Published by Kowsar Corp.; Published by Kowsar Corp. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work
is properly cited.

Shamsi-Baghbanan H et al.
one of the most famous books in the history of medicine
(6). On the other hand, evidence indicates that detailed
study of the Canon and comparing it with new findings can lead to finding plants having biological effects.
Hence, in this research we investigated the Canon to find
herbs which have hepatoprotective effect from the viewpoint of Avicenna.
The Canon of Medicine is composed of five volumes.
The first book is about general Anatomy and principles of
medicine, and the second book deals with Materia Medica. The third book covers the function and diseases of
each organ. Book 4 is about diseases that affect the whole
body like fevers, and book 5 deals with compound drugs.
In the 2nd book, about 800 materia were introduced
which are mostly herbal (6). In this book, each medicinal
property was described with specific terms. For example,
Moghavi is an effect defined as follows: A drug effect
which moderates the disposition and temperament of
an organ to an extent so that it prevents the superfluous
matter and disorders moving toward it (7).
A drug effect with a Moghavi property prevents liver
from injuries or diseases. This definition is similar to
hepatoprotective effect. Hepatoprotective agents are
those compounds, which mitigate the liver injury caused
by hepatotoxic agents (8) thus can prevent damage to
the liver. Although some scholars considered fortifying,
tonic and strengthening (7).

term hepatoprotective was searched without narrowing and limiting search elements only in the English
articles. Liver protective drugs were also extracted. The
searched databases included Cochrane library, Web of
science, SID, Irandoc and IranMedex up to June 8, 2013. All
human and animal studies that included the evidences of
the effects of hepatoprotective herbs with any outcomes
were selected for the review. Clinical trials (any phase)
were identified for data abstraction and observational
studies. Only publications without available abstracts
and letters to the editor were excluded from the review.
Unpublished data were also excluded from the study. Duplication was avoided by excluding review of multiple
copies of the same article in several databases. Flow of the
study is in Figure 1.
References retrieved from databases
were 3724 article

3268 were excluded on the basis of

title

Article abstract read (456)

2. Objectives

Excluded duplicate abstract, read (17)

Considering the aforementioned definition, and as the

English equivalent for Moghavi, protective is a more suitable and accurate equivalent. Therefore, it seems that a
drug with Moghavi effects on liver is a hepatoprotective
drug, therefore the Canon was investigated to find herbs
having such properties.

3. Materials and Methods

Three different versions of the Canon were prepared

and utilized: 1- the corrected version of Canon in Arabic
(9), 2- Arabic manuscript of the Canon (10), and 3- Translated version of the Canon in English (7). As the first step,
to indicate which hepatoprotective herbs or compound
drugs Avicenna had prescribed for liver diseases, the
3rd volume of the Canon under Liver Disease topic were
searched. To find the scientific names of plants we took
advantage of three botany references (11-13) and if two or
three books agreed about that name, the scientific name
was chosen; if the scientific names of plants were not
found, the botanical descriptions were recorded instead.
Eventually, the reports of their hepatoprotective effect
in the available articles were investigated. And then the

Excluded on the basis of abstract

(388) and conference proceeding
without abstract form (8)
Article retrieved and read in full text
(43)
Figure 1. Flow of the Study

4. Results
Avicenna introduced 19 herbal parts as hepatoprotective that their characteristics are given in Table 1. Old
names of hepatoprotective compound drugs, plants used
in them, their usage and frequency of their prescription
in liver disease which is mentioned in the 3rd volume of
the Canon are given in Table 2. Since the components of
Marham Dawa Al-Amdhun as one of the hepatoprotective
compound drugs was not found in the Canon and other
available pharmacology books, this drug was not mentioned in the Table 2.

Iran Red Cres Med J. 2014;16(1):e12313

Shamsi-Baghbanan H et al.
Table 1. Data from the Second Volume of the Canon about Hepatoprotective Herbs
Traditional
name

Ambarbaris

Joze boa

Basbaseh
Darchini

Zafaran
oufd

Ghafeth

Qaranful
Luk

Family

Hil boa
Mastaki
Balsan

Plants Temperament

Pharmacological Model Used

to Examine
Hepatoprotective Effect

Myristicaceae

Liver, stomach, Kernel of seed 1

spleen, eye

Cisplatin/ Mice
(15)

Liver, stomach

Peel of seed

Mice/Cisplatin
(15)

Liver, stomach

Stembark

20

Rat/CCl4 (16),
Mice/Ethanol
(17), Rat/CCl4
(18)

Viscera, stomach, ,heart,

lung, liver
Viscera, Heart,
Stomach, liver

Stigma and
style

19

28

Mice/Rifampin
(19)

stem

-a

liver

flower

20

Rat/CCl4 (20),
Rat /Ethanol
(21)

Stomach, liver

Dried buds

10

liver

Gum

12

Rat/
Paracetamol
(22)
-b

Stomach, liver

Flower and
leaf

-a

Stomach, cold
liver

Root

Rat/
Paracetamol
(23)

Cold liver, cold Fruit

stomach

Rat/CCl4 (24)

Liver, Stomach, Gum

small intestine

34

Rat/CCl4 (25)

liver

Mice/CCl4 (26)

- c (27)

Lauraceae

Iridaceae

Thymelaeaceae

Asteraceae,
Rosaceae

Myrtaceae

Terebinthaceae

Araceae

Zingiberaceae

Anacardiaceae

Burseraceae

Usutkhuddus Labiatae

Iran Red Cres Med J. 2014;16(1):e12313

Fruit

Frequency of Use in Liver

Disease
As a Part of
As a Part
Hepatoprotec- of Other
tive ComCompound
pound Drugs Drugs
0
10

Liver, stomach

Myristicaceae

"cold" in the third

phase of the third
grade, "dry" in the
third phase of the
third grade
Myristica fra"hot" in the last
grans (11-13)
phase of second
grade, Dry in the
last phase of second
grade
Myristica fra"hot" in the second
grans (11-13)
grade, "dry" in the
second grade
Cinnamomum "hot" in the third
zeylanicum (11, grade, "dry" in the
12), C. cassia (12, third grade
13), C. verum
(11, 13)
Crocus sativus "hot" in the first
(11-13)
grade, "dry" in the
first grade
Aquilaria agal- "hot" in the second
locha (11, 13),
grade, "dry" in the
A. malaccensis second grade
(11, 13)
Eupatorium
"hot" in the first
cannabinum
grade, "dry" in the
(11, 12), Agrimo- second grade
nia eupatoria
(12, 13)
Syzygium
"hot" in the third
aromaticum
grade, "dry" in the
(11-13)
third grade
Extract from
"hot" in the second
this family
grade, "dry" in the
(11, 13)
third grade
Ruscus aculea- "hot" in the second
tus (11-13)
grade, "dry" in the
second grade
Acorus cala"hot" in the first
musl (11-13)
phase of the second
grade, "dry" in the
first phase of the
second grade
Elettaria carda- "hot" in the second
momum (11-13) grade, "dry" in the
second grade
Pistacia lentis- "hot" in the second
cus (11-13)
grade, "dry" in the
second grade
Commiphora "hot" in the second
opobalsamum grade, "dry" in the
(11-13)
second grade
Lavandula stoe- "hot" in the first
chas (11-13)
grade, "dry" in the
second grade

Organs Which Used Part

the Herb has
Protective
Effect on

Berberidaceae Berberis vulgaris (11-13)

Murdesfaram Asparagaceae
Waj

Scientific
Name

Wood, gum,
fruit

Viscera, urinary Flower

organ, body

Mice/CCl4 (14)

Shamsi-Baghbanan H et al.
Armak

A Yemenite fra- "hot" in the last

Viscera, heart, 0
0
grant rind like phase of the second brain
Cinnamon
grade, "dry" in the
last phase of the
second grade
Ward
Rosaceae
Rosa damaCold in the first
Internal organs Petals
0
22
Rat/CCl4 (28)
scene (11-13)
grade, "dry" in the
first phase of the
second grade
Kashuth
Cuscutaceae
Cuscuta mo"hot" in the first
Stomach, liver Whole Plant 0
11
- d (29)
nogyna (11-13)
phase of first grade,
and seed
"dry" in the last
phase of second
grade
Sak
Euphorbiaceae Phyllanthus
"hot" in the first
viscera
fruit
0
1
Rat /Ethanol
emblica (11-13) grade, "dry" in the
(30)
second grade
a Based on our research, the hepatoprotective effect of this species, genus, and family have not been studied.
b Based on our research, the hepatoprotective effect of this family has not been studied.
c Based on our research, although in this family hepatoprotective effect was reported but this species and genus have not been studied.
d Based on our research, although in this genus hepatoprotective effect was reported the species has not been studied.

0
0
0
7
0
1
1
10
0
0
1
0
0
0
0
0
1
0
0
0

Intake method

Frequency of citation in liver diseas

suk

Kashuth

Ward

The found plants belong to 17 different families. Seventy-five percent of the plants found in this research are
reported to have confirmed hepatoprotective effects
just the same way as their scientific names. Such reports

Armak

Ab
malumali
al-habb al-jami, made by Ibn Jahan

Dawa-al-lak al-akbar

Dawa-al-lak al-asghar
habb e-Astmehighon attributed to al-kindi

Marham be- shahm-e- hanzal
Dawa al- kurkum
Jawarish-e- khuzi

Jawarishn-e- jalinus

Majun- al-khabth

Jawarishn -al-darsini
Safuf-e-ebadat
Bb
Tiryaq-e- kabir

Majun-al-kinidi

Majun-al-mosk
Majun-e- shajarina-e-kabir
Majun-e- shajarina-e-sagir
Majun-e-anqardia
Total sum
0 3
2
12 13 5
2
9 3
0 2
4 8 8
a Other plants were also used in formulation of these drugs but only hepatoprotective herbs were mentioned.
b There is no Specific Name for it in the Canon.

Usutkhuddus

Balsan

Mastaki

Hil bawwa

Waj

Murdasfaram

Luk

Qaranful

Ghafith

oud

zafaran

Darchini

Basbaseh

Jauz buwwa

Amberbaris

Traditional Name of Compound

Drugs a

Table 2. Properties of Hepatoprotective Compound Drugs Extracted From the 5th Volume of the Canon

oral
oral
oral
oral
oral
oral
Topical
oral
oral
oral
oral
oral
oral
oral
oral
oral
oral
oral
oral
oral

are also about genus of 5% of plants and family of 5% of

plants. There is no report about hepatoprotective effect
of 15% of plants composed of 3 plants. The parts of plants
used are as follows:
Iran Red Cres Med J. 2014;16(1):e12313

Shamsi-Baghbanan H et al.
Flower or flower parts: 6 items (27.27%); fruit: 4 items
(18.18%); grain or parts of grain: 3 items (13.63%); Stalk or
stem bark: 3 items (13.36%); plants gum: 3 items (13.63%);
leaf: 1 item (4.54%); root: 1 item (4.54%); the whole plant:
1 item (4.54%). With regard to Table 1, the most common
hepatoprotective plants prescribed for liver disease under the formulation of hepatoprotective compound
drugs are respectively as follows: Cinnamomum spp
(Darchin), Crocus sativus (Zafaran), Syzygium aromaticum
(Qaranful), Pistacia lentiscus (Mastaki), and Commiphora
opobalsamum (Balsan). Taking Table 1 into account, most
of the hepatoprotective herbs prescribed in liver disease,
in formulations other than hepatoprotective compound
drugs, are respectively as follows: Mastaki, Zafaran, Ward,
Ghafeth, Luk, Kashuth, Ambarbaris, and Darchin. Considering Table 2, the plants frequently used in formulation
of compound drugs are respectively as: Zafaran, Darchin,
Qaranful, Balsan, and Mastaki.

5. Discussion

The word "Moghavi", and its synonyms, which means

"Protective" and also words such as "Jeghar" and "Kabed"
which both mean "Liver" were searched in the 2nd volume
of the Canon. Every time one of these words was found,
the due text was studied to determine which plant it is
about, and the relation with its hepatoprotective effect
was investigated. Traditional medicine of Iran is based on
the theory of the presence of Nature in human organs,
and that each organ and part of the body is eligible to
have a specific amount of "cold" or "hot" nature and also
a certain amount of "moist" or "dry" nature. An effect of
drugs on body is variation of quality of Natures. If a drug
changes the temperament of body toward Hot, it is said
to have "hot" temperament and if it changes the nature
of body to "cold" it is called to have "cold" temperament,
and so forth for other natures. Ability of drugs to change
the nature is divided into four grades and each grade is
composed of 3 phases. The higher the grade of a drug, the
more its ability to change body nature , hence a drug with
the 1st grade will slightly change the nature of organ but
causes no change in its functionality. The 2nd grade drug
makes minor changes in nature and functionality but
does not harm the organ. A drug of the 3rd grade alters
nature and functionality of organ considerably and may
lead to organ damage, but does not cause its death. Drugs
in their 4th grade are strong enough to lead to death of
organ. It is noteworthy that drug effectiveness in phase
3 of the same grade is much more than equivalent drug
in phase 2 of the same grade and effectiveness of phase
2 of the same grade would be more than effectiveness of
phase 1 for that grade.
Temperament of 89% of plants is "hot" and "dry". This
may indicate that in order to have suitable hepatoprotective effect, temperament must be "hot" and "dry". The average temperament of these plants was "hot" in the 2nd
phase of the 2nd grade and "dry" in the 3rd phase of the
Iran Red Cres Med J. 2014;16(1):e12313

2nd grade. Based on definition of plants` temperament

grades and their effects on the body, we can claim that
most of the drugs selected on the basis of traditional
medicines are safe and relatively with no side effects.
Based on our survey in the Canon, 19 herbal parts with
hepatoprotective effects were found. Since both joze boa
and Basbaseh belong to the same plant and no scientific
name was found for Armak, and on the other hand, there
were two or three different scientific names for some old
plants, 22 scientific names were assigned for evidenced
based studies of the 17 recognized plants.
Considering that the plants belong to 17 different families perhaps indicates that the hepatoprotective properties are not unique to a family. Given that the most frequently used parts of plants were flowers or flower parts
(27.27%) and fruits (18.18%) implies that these parts of
plants may be a better choice for extracting hepatoprotective materials. Most plants have simultaneous protective effect on several organs but the protective effect on
liver usually accompanies with protective effect on stomach (83%). This perhaps explains the existence of a joint
mechanism for protecting the liver and stomach.
All plants introduced by Avicenna were prescribed as a
part of hepatoprotective compound drugs, or other formulas in liver diseases. The present studies have reported
the hepatoprotective effect in 85% of these plants; therefore continuation of these studies to make an effective
drug for liver diseases is promising. On the other hand,
plants such as Aquilaria agallocha, Aquilaria malaccensis,
and Ruscus aculeatus whose hepatoprotective effects have
not yet been reported are considered as good candidates
for future investigations. In a survey (31), hepatoprotective effect of a Unani compound drug with the title of
Majoon-e-Dabeed-ul-Ward was proven. Fifty-five percent
of plant ingredients used in formulation of this drug is
the same as plants introduced in this paper that confirms
the right choices of Avicenna.
Ninety percent of the compound drugs are oral intake
and the remaining 10% must be rubbed on the body. It
is interesting to note that there is no hepatoprotective
herb in formulation of drugs which must be rubbed but
all of them exist in formulation of oral intake drugs and
this indicates that oral prescription is probably a better
choice for hepatoprotective effectiveness and verifies
that the mechanisms of drug effectiveness in both cases
of oral intake and rubbing is different. Considering the
fact that often several hepatoprotective herbs have been
simultaneously used in formulation of hepatoprotective
compound drugs they are likely to have synergistic effects that need to be studied further. Most frequently the
prescribed hepatoprotective compound drugs for liver
diseases are Dawa-al- kurkum and Dawa-al-lak al-akbar.
Interestingly, both plants of Zafaran and Darchin exist
in both formulas and Balsan, Mastaki, and Qaranful are
used in Dawa al-lak al-akbar formula and these 5 plants
are the ones most frequently used in formulation of
5

Shamsi-Baghbanan H et al.
compound drugs. The survey results revealed that three
most frequently used plants for liver disease are Zafaran
(47 cases), Mastaki (43 cases), and Darchin (28 cases), respectively. However, Zafaran and Darchin are two plants
that have been mostly used to produce compound drugs.
On the other hand, these two plants are being used as the
flavor in many countries including Iran. Therefore, these
two plants are proposed for more investigation and construction of hepatoprotective drugs.

Acknowledgements

This paper is derived from PhD, School of Traditional

Medicine, Shahid Beheshti University of Medical Sciences
thesis under the title of "Explanation of Etiologies and
Clinical Manifestations of Liver Diseases According to
Iranian Traditional Medicine and Clinical Manifestation".

Authors' Contributions

Dr. Hamid Shamsi-Baghbanan has done the research.

Dr. Afsaneh Sharifiyan verified the translation of word
''Moghavi'' to Hepatoprotective and some other words.
Dr. Somayeh Esmaeili verified traditional and scientific
names. Dr. Bagher Minaei has conducted and reviewed
the entire research.

Financial Disclosure

The authors have declared no conflict of interest.

Funding Support

11.
12.
13.
14.

15.
16.

17.
18.
19.

20.
21.
22.

23.

There is no funding support.

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